[Sacituzumab govitecan in ER+/HER2- breast cancer: a necessary treatment option for patients who have undergone multiple prior treatments.]

Abstract

A 65-years-old woman underwent right mastectomy in 2010 for invasive ductal carcinoma of the breast (HR=95% PgR=18% ki67= 25% HER2= 0). Stage pT2(30mm)pN1(2/10)M0. She started adjuvant chemotherapy then endocrine therapy. In March 2021 a CT scan showed suspected right breast and axillary lymph node recurrence; a biopsy confirmed the luminal B, HER2- phenotype. Surgery was excluded, so she started CDK4/6 inhibitor and letrozole. One year later she started palliative radiotherapy. Because of further skin and lymph node progression, the patient began everolimus and exemestane in July 2023. The patient continued this treatment for only three months, because a new CT scan showed skin, subcutaneous and axillary lymph nodes progression. The patient started capecitabine and vinorelbine. Subsequent CT scans showed further disease progressions especially in the right axilla, leading to obstructed lymphatic drainage and consequently to upper right limb elephantiasis. Several skin nodules involving the right hemithorax were associated. The patient wore a cuff to limit oedema and started further chemotherapies, without any clinical improvement. Subsequent CT scans otherwise revealed radiological liver and bones lesions. In March 2025 she began sacituzumab govitecan (SG): after the first month, clinical examination revealed partial remission of subcutaneous nodules and pathological lymph nodes in the right axilla, gradually leading to cuff removal. The possibility to use SG in luminal breast cancer patients gave this woman a chance, in a scenario poor in exciting options.